Cardiac Syndrome X

Classification according to ICD-10
I20.9	Angina pectoris, unspecified - angina pectoris syndrome
ICD-10 online (WHO version 2019)

With cardiac syndrome X (nowadays more microvascular angina pectoris , English coronary microvascular disease and small vessel (heart) disease ) the patient suffers from angina pectoris , the ECG shows changes as in ischemia , but the coronary arteries appear normal in the coronary angiography . Patients have a good prognosis: neither mortality nor the risk of cardiovascular events are increased; however, the quality of life is impaired.

causes

Various physiological mechanisms are discussed that can lead to Syndrome X; The syndrome is likely to have several causes:

In particular, a dysfunction of the endothelium of the small (intramural) coronary vessels is discussed. Thus, the arterial vessels in the heart muscle , which can not be represented in the angiography, due to increased endothelin - blood plasma levels narrowed. Since around 70% of patients are menopausal women , a lack of estrogen presumably also plays a role. Furthermore, an increased sensitivity to pain is described in many patients .

Diagnosis

After a positive exercise ECG and a negative angiography, the myocardial perfusion under stress can be examined by myocardial scintigraphy or by MRI ( cardio-MRI ). The determination of the coronary flow reserve and the examination of the endothelial function with the help of flow-mediated dilation on the upper arm artery are also beneficial .

therapy

• Beta blockers or calcium channel blockers to reduce chest pain
• to improve endothelial function, hormone replacement therapy, if necessary, and reduce risk factors for coronary heart disease

See also

• Prinzmetal's angina

Individual evidence

1. ↑ JC Kaski: Pathophysiology and Management of Patients With Chest Pain and Normal Coronary Arteriograms (Cardiac Syndrome X). In: Circulation. (2004); 109, pp. 568-572. PMID 14769677
2. ^ EA Asbury et al .: Cardiac Syndrome X. In: Int J of Clin Prac. Volume 59 (2005), Issue 9, pp. 1063-1069. PMID 16115183

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !